低價值醫療之探討

A review of low-value care

全球的衛生醫療保健支出逐年上漲，各國開始針對「無效率照護」、「過度使用醫療資源」等議題進行討論，因此「低價值醫療」（Low-valuecare）一詞逐漸備受重視。低價值醫療可能導致醫療費用上升、病人身體與心理傷害、壓縮高價值的醫療服務資源供給，更甚者可能造成醫源性傷害（Iatrogeni charm）的發生，因此若減少低價值醫療的利用，能減少不必要的治療與後續相關醫療費用支出。本研究整理低價值醫療議題的發展脈絡，接著釐清造成低價值醫療在「臨床人員」、「病患」以及「醫療體系」三個不同面向的因素，同時探討低價值醫療對於病患及醫院端的影響，最後整理出近年來各國低價值醫療利用現況、政策介入與改善情形，進一步探討台灣未來針對低價值醫療可以改善的方向與目標。 The rising cost of health care has raised concerns about the provision of “ineffective care,” “inefficient care,” and “unwanted care” in many countries. “Low-value care” has received attention because it can increase the cost of health care, cause physical and mental harm to patients, including iatrogenic harm, and reduce the availability of high-value health care services. Efforts to reduce the prevalence of low-value care can, therefore, reduce the incidence of unnecessary treatments and their accompanying costs. This paper reviews the contexts in which low-value care occurs and investigates the manner in which clinicians, patients, and health care systems contribute to the prevalence of low-value care. This paper also discusses the effect of low-value care on patients and health care providers. Finally, we summarize the current status of policies and interventions aimed to curb the provision of low-value care in several countries to illuminate potential targets for policy interventions and solutions to reduce the provision of lowvalue care in Taiwan.